Faculty test-beds - West London: clinical placement strategy

Tracking down the placement tariff funding

It became clear pretty quickly that there wasn’t a central point of coordination for student placements. I had come from an organisation with a background of that, so it was an obvious one for me to tackle first. I wanted to get a sense of what was going on: some areas were really proactive, but others weren’t. We have a large number of AHPs (300) and there was such a big opportunity for us as a community, to be taking a large number of placements.

In my previous trust, we had used the HEE MNET placement tariff funding to fund a Placement Coordinator role. I thought maybe I could do the same in West London, so I set about trying to locate that pot of money.

I’ve spoken to many AHP leads about this over the years and it truly is a piece of forensic accounting work, as it tends to get bundled in with other funding. I went around the houses, speaking to various finance people, as well as several people from HEE. After three months I had a breakthrough. I was able to track down the individual in finance who was responsible for the MNET money. I had a conversation with him and within hours he had located the data: line by line had each professional group and how much money they’d had per quarter.

My next question was “how much is it and how do I get my hands on it?”. The MNET money was going into the Director of Nursing’s education pot and I knew by accessing that money I was going to leave a hole in her budget. I know how tricky these conversations have been for other AHP leads elsewhere: we’re accustomed to having to negotiate and strive for equity, so I had lined up a whole argument and rationale. However, I was lucky - I had a very supportive DoN who just got it and there was no hesitation in reassigning these funds to AHPs.

What’s the data telling us?

We went about validating the data: totalling the number of placement hours we had done and checked to see whether it tallied with what HEE were paying us for. This is where it gets really complicated, but fundamentally the money is never right, and we are always left out of pocket.

In London we use the PMP placement management programme platform. Universities pay Tribal to use PMP and providers therefore access it to manage their placement and Practice Educators across London. You can find precisely the students that you want to bring in: e.g. a third-year physiotherapy student, however keeping PMP up to date is a full-time job in itself and I can’t imagine how trusts are managing this without education capacity. As a large trust with a high number of AHPs, we could have 80 students from five universities at any given time. We also take elective placements and international students. I can see why this system was created and that it was intended to address the transparency and availability of placements over a geography, but it has a number of shortcomings and needs significant investment to make it fit for the 21^st century.

Our strategy

Our original plan was to do a baseline audit of what could the placement capacity be. We didn’t set a goal, simply that we wanted to increase placements and then were delighted that it increased so much (50% within a year). With my improvement hat on, just imagine what we could achieve with a target.

Our approach was to get under the skin of understanding our own landscape as much as possible:

1. Get the baseline data – by hook or by crook. If you’re willing to rely on local placement platform data being accurate, it will tell you how many placements are being made.
2. Your placement data will also tell you how many have been accepted. It’s worth double-checking that they are all being accepted and if not, why not.
3. Ask all of your AHPs in your organisation how many students they have taken – go back two, but ideally three years. Some people will be super organised, others won’t be so organised.
4. How do you contact all of your AHPs? Do you know where they all are and how to reach them?
5. Keeping track of your AHP body. We started a “Leavers & Starters” agenda item at our monthly senior AHP leads meeting. It’s a pretty analogue way of doing things but we now have an all AHP email list.
6. Understand why practising AHPs don’t take student placements – if you don’t hear their perspective, you’ll go nowhere.
7. Ultimately people choose to do this. It shouldn’t be the case - it should be part of your JD. But if you don’t try and work with people on this, it will move slowly.

Starting the conversation – and the subsequent ripple effect

We started the conversation with the AHP body at all levels and beyond. I looked at whether there was concerted energy about it in the trust and if it was coordinated. It was potluck before, if we got keen people participating, so I set about finding out what might work for our AHPs to accept students and what was putting people off.

We did a survey and uncovered the barriers to AHPs taking on placements which were broadly:

1. time
2. resources (which ranged from office space, access to IT, being short-staffed)
3. “I don’t feel experienced enough” or “I haven’t taken a student for 10 years”

We explored how best to use placements and whether we should structure them differently: e.g. splitting them; utilising them to help Practice Educators on a specific project as opposed to simply having someone shadowing them for weeks.

We started to put the topic of student placements on various meeting agendas and suddenly the conversation was having a ripple effect and people started taking students. 

Supporting practice educators

Being a Practice Educator comes with a lot of professional responsibility, but also an emotional challenge too. It can be a very intense dynamic and you feel responsible for students’ careers as you know you hold their career in your hands.

We have an AHP trust-wide AHP forum and we also set up an AHP Practice Education Group which meets quarterly and is solely dedicated to discussing student placements. Our AHP Education Lead chairs it and it is a reflective practice group. We time it during the peak of large cohorts of groups and crucially, we provide them with the space to discuss everything warts and all – providing a forum for people to get worries out of their system.

The power dynamic of that intense placement relationship is massive. It can be especially challenging if students simply aren’t “getting it” and responding to strategies – in which case you have to be accountable and not pass them. Nevertheless, this can be an exhausting and challenging time. The nature of AHP professions is to enable, and so on the occasions where students are unable to progress can be a difficult period. When you have a failing student, that performance management process takes over and is very time consuming - but quite simply, failing someone is a horrendous experience, so peer support makes a huge difference.

People in their first year of practice – are called preceptees (year of preceptorship) - can’t be practice educators in the first year, but they can co-supervise. In the second half of their preceptorship year, we say to them to think about doing their practice education training and we buddy them up with an experienced person. Establishing a discipline of being a Practice Educator at the beginning of your career will hopefully set AHPs up for being lifelong educators.

The administrative nightmare

This is a minefield and people underestimate how complex, intense and time consuming this is. We are dealing with multiple professions; multiple universities and multiple placement structures with completely different paperwork.

Nursing students just turn up and the placements are waiting for them, whereas we have to ask and negotiate forensically. That culture really needs to change if the health and social care system is to harness the full potential of the AHP workforce.

Infrastructure

Critically we don’t have the infrastructure to organise this as AHPs. I sit in an office with six workers who are solely dedicated to supporting clinical nursing placements. There’s exhaustive support for this in nursing but we have just one Placement Co-ordinator working 1.5 days a week. There’s an absence of parity that needs a co-ordinated case for change.

RECIPE CARD

A key checklist to drive value

1. Understand your landscape: diversity of AHP body; reporting structures; HIE relationships; faculty members and their pressures.
2. Get your baseline data: by hook or by crook. If you’re willing to rely on local placement platform data being accurate, it will tell you how many placements being made.
3. Check how many placements have been accepted: Your placement data will also tell you how many have been accepted. This is another thing worth double checking why it’s happening and whether you need to make any adjustments.
4. Ask AHPs what they’ve been doing and how?: Ask all of your AHPs how many students they have taken – go back two but ideally three years.
5. Build your comms channels with your AHP body: Have a means of contacting all your AHPs. Do you know where they all are? Keep track of your AHP body with an all AHP email list; create a leavers and starters agenda item at monthly senior AHP leads meeting. Triangulate that data against the HEE tariff.
6. Understand why AHPs don’t take student placements: if you don’t hear their perspective, you’ll go nowhere.
7. Support Practice Educators: Ultimately people choose to do this. Give them training, support and channels for peer support.
8. Build infrastructure: lobby to have equity in the education and training team; make the case for funding the co-ordination of training and professional development on a par with medical and nursing education resource.
9. Set targets: Agree targets with colleagues and use improvement methodologies to plan, do, study and act.